Parenteral ergometrine is widely used for the prevention and treatment of
excessive uterine bleeding following birth. Unfortunately, in tropical climates it is often found to contain very little
active ingredient: only 32 of 100 field samples from Bangladesh, Gambia, Malawi, Yemen and Zimbabwe contained 90-110% of the amount
of active ingredient stated on the label, and 34 contained less than 60%. In this paper the results of nine studies, of
which eight were initiated and coordinated by WHO, are reviewed to formulate answers to the following questions:

what is the
extent of the problem of low potency of ergometrine in tropical climates;

is the problem due to instability or low initial
quality, or both;

which practical measures can assure the quality of injectable ergometrine; and

are there any alternative drugs
which are more stable?

Injectable ergometrine is very unstable under tropical conditions and particularly if stored unrefrigerated and
exposed to light, when it may loose up to 20% of its potency per month. However, there are differences between brands. Practical
measures to assure the quality of injectable ergometrine therefore include a careful supplier selection and refrigerated
storage. Ergometrine injection should always be protected from light until given to the patient. Loss of active ingredient can
easily be detected by regular visual checks of the colour of the solution. Any discoloration implies that the solution contains
less than 90% of the stated amount of active ingredient, and should not be used. Methylergometrine is no more stable than
ergometrine. Parenteral oxytocin is more stable than both ergometrine and methylergometrine injection. Oral and buccal dosage
forms are less stable than injections. In view of the better stability in tropical climates, similar cost, fewer side effects and
comparative efficacy, parenteral oxytocin, rather than parenteral ergometrine, is the drug of choice in the prevention and treatment of
postpartum haemorrhage.